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Pneumococcal carriage tends to be more prevalent in communities where more children attend child care centers

Children are often carriers of the pneumococcal bacteria (called "pneumococcal carriage") that can cause pneumonia, ear infections, sinus infections, and other infections. The prevalence of carriage with pneumococcal bacteria in children varies from 14 to 52 percent across communities.

Factors such as age and number of siblings, account for some of these community differences. However, community-level factors can also be substantial, such as the proportion of children in a community who attend child care centers (CCCs), concludes a study supported in part by the Agency for Healthcare Research and Quality (HS10247).

Researchers led by Jonathan A. Finkelstein, M.D., M.P.H., of Harvard Medical School, developed a pneumococcal transmission model to evaluate whether the combined risks of attending CCCs and associating with playmates who attend CCCs account for a large proportion of the variability in the prevalence of pneumococcal carriage across communities. They used the model to analyze data from asymptomatic children in 16 Massachusetts communities. The model predicted that the odds of carriage associated with CCC attendance for an individual child were two to three times the odds associated with no CCC attendance.

In addition, CCC attendance may account for variations of 4 percent to 56 percent in prevalence of carriage across communities, according to the model. Using the model, Dr. Finkelstein and his colleagues calculated that, in a community where 24 to 65 percent of the children attended CCCs, the odds of pneumococcal carriage for nonattendees were 3.7 to 5.8 times the odds of carriage in a community with no CCC attendees. In a community in which the mean weekly time spent in CCC attendance was 20 hours, the increased risk of carriage was 2.3, which increased to 3.3 when mean weekly time rose to 30 hours, and to 5 when it was 40 hours.

More details are in "Modeling community- and individual-level effects of child-care center attendance on pneumococcal carriage," by Susan S. Huang, M.D., M.P.H., Dr. Finkelstein, and Marc Lipsitch, Ph.D., in the May 1, 2005, Clinical Infectious Diseases 40, pp. 1215-1222.

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